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Biomedical subjects

P Rosat

Publications and source records attributed to P Rosat.

At least 19 recordsLinked to original sources
PubMed1992

[A case report of Russel's diencephalic cachexia].

The case of an infant admitted for evaluation of severe emaciation with intermittent ocular anomalies including strabismus and nystagmus is reported. This case demonstrates the value of magnetic resonance imaging and transfontanellar ultrasonography for the diagnosis of diencephalic syndrome of infancy. The prognosis of this condition is usually grim, in particular because of the severe emaciation which is disproportionate with the tumour spread. Pathophysiologic hypotheses put forward to explain this cachexia are reviewed. Although cytokines such as TNF alpha are currently incriminated in the pathophysiology of cachexia induced by a number of conditions, they have not yet been studied in diencephalic syndrome of infancy. TNF alpha is a potent lipolytic agent. Excessive production of TNF alpha may be involved in the genesis of the emaciation characteristic of diencephalic syndrome. Inappropriate production of TNF alpha may respond to the administration of specific anti-TNF monoclonal antibodies. This approach may be considered as a means for treating emaciation in patients with diencephalic syndrome of infancy.

Astrocytoma↗
PubMed1988

[Current therapeutic attitudes on pneumothorax in adults].

Recent advances in thoracoscopy and surgical procedures have led to modifications in therapeutic approaches to easily diagnosed pneumothorax. These procedures make it possible to adjust therapy to the severity and underlying causes of the disease which may vary from simple bullous dystrophy to neoplasia. For simple pneumothorax, a suitable treatment may be to put the patient under observation or exsufflation, but thoracoscopy has the advantage of visualizing the lesion and, in certain cases, enables it to be treated. Surgery is indicated when an extensive bullous system is seen at thoracoscopy or when this technique is unsuccessful. A considerable reduction in the risk of relapse of this usually benign condition should be expected.

Emergencies↗
PubMed1987

[Cavo-suprahepatic lesions in severe hepatic injuries. Repair under extracorporeal circulation].

Liver injuries always have a sombre prognosis. Triple or quadruple clamping has been suggested to control haemorrhages, but the risk of the heart running dry has warranted internal shunts which have only been successful in odd cases. The severity of these lesions justifies a temporary packing pending admission in specialized unit for subsequent treatment. A final treatment may be undertaken under extracorporeal circulation. In the case reported here, the superior right hepatic vein was sutured and the holes of the infrahepatic vena cava related to the tearing of middle and inferior right hepatic veins or the dorsal veins of segment I could be repaired. Rupture of the renal pelvis was also repaired.

Constriction↗
PubMed1987

[Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty].

Findings in several cases are used to demonstrate that certain vertebral angiomas may not be congenital and can ultimately provoke medullary or radicular neurologic complications. Radiotherapy is the usual treatment but is not always accepted unconditionally close to spinal cord. Destruction of angioma and consolidation of vertebral column can be obtained by percutaneous intrasomatic injection of acrylic cement. The preoperative radiologic examination includes direct phlebography with insertion of trocar, the vertebroplasty being performed under television screen surveillance. Results in seven patients treated are very encouraging but the current 2-year follow up requires extension. However, the method appears to be able to be included amongst treatment for an affection of sometimes seriously questioned benign nature.

Adult↗
PubMed1986

[Repair of a suprahepaticocaval injury under extracorporeal circulation].

The case of a 29-year old man who presented with haemorrhage from hepatic veins and the retrohepatic vena cava is reported. On the belief that a conventional technique would be dangerous, total extracorporeal circulation was used as a supportive procedure. The method facilitated anatomic definition of the venous injuries. The repair could then be calmly and precisely carried out because of a practically bloodless operative field. The procedure was well tolerated and the postoperative course was uneventful; the patient was discharged 15 days later. Many surgical techniques have been described for the repair of traumatic injuries of the inferior vena cava and hepatic veins, but all with a high level of peroperative mortality. So, cardiopulmonary bypass and hypothermia seemed to be a useful procedure. However, some points need further consideration: heparin administration may promote bleeding from other lesions and, in the case of associated gastrointestinal injuries, the risk of major septic dissemination is great.

Adult↗
PubMed1986

[Vascular injuries of the limbs. Evaluation of 106 lesions in 76 patients].

A total of 106 lesions due to vascular injuries (noniatrogenic) to limbs were treated in 81 patients at the CHR, Rennes (Cardiovascular and Thoracic Unit) between 1970 and 1983. Analysis of data allowed a profile of arterial lesions (type and location) to be retraced, and demonstrated the high frequency of associated lesions, these varying in distribution according to whether the upper limbs (major seriousness of neurologic sequelae) or lower limbs (very high incidence of osteoarticular lesions) were involved. Among the "immutable" severity factors (related to the injury) emphasis has to be placed on "contending or crush injuries", widely displaced lesions, extensive arterial dilacerations (middle segments of limbs) and multiple vascular lesions. This study focused attention mainly on the tactical and technical factors allowing improvement in the always reserved prognosis of these lesions. Firstly, by maximum reduction in the duration of ischemia by early diagnosis (to avoid referral to a "second hand") and by judicious indication for angiography (conducted preferably in the operation room and if necessary repeated after vascular repair surgery). Secondly, by repair of lesions in conformity with well established rules and principles: bone stabilization initially, formal venous repair surgery for large venous trunks, preferably "conservative" surgery of arterial vessels to ensure a perfect result initially (any recovery operation results in a very high incidence of failures).

Adolescent↗
PubMed1986

[Mural thrombosis of the abdominal aorta. A sometimes unrecognized cause of recurrent embolisms].

A 23 year old patient with an infrarenal abdominal aorta mural thrombosis developed recurrent peripheral emboli. This case underlines the etiologic investigation necessary in cases of peripheral emboli unexplained by the conventional cardiac examinations. Filling of total aorta with contrast is essential (assisted if necessary by oblique projections) to detect possible mural thrombi carrying the risk of recurrent emboli.

Adult↗
PubMed1986

[Multiple intracranial aneurysms. A very peculiar case of 8 sylvian aneurysms].

Reports vary with respect to frequency of multiple aneurysm but they are observed in an average of 13% of intracranial aneurysm cases. Multiple aneurysms generally involve several intracranial vascular trunks but those affecting the vertebrobasilar system and middle cerebral artery are the most common combinations. It is rare for more than two lesions to be located on the trunk of a same vessel. These data emphasize the exceptional nature of the clinical case presented. The eight aneurysms detected in this patient were all situated on the left sylvian artery and its proximal collaterals. Rupture of one of the aneurysms had provoked haemorrhage into sylvian fissure. All eight aneurysms were treated by eleven clamps during the course of a one-stage operation. Full recovery, with completely normal clinical and review arteriographic results, was obtained despite the postoperative onset of a right hemiplegia with aphasia.

Adult↗
PubMed1985

[Partial interruption of the inferior vena cava by an endovenous filter. Apropos of 98 patients].

94 partial interruptions of the inferior vena cava (PIIVC) were carried out in 98 patients between May 1979 and November 1983 with a Mobin-Uddin umbrella filter (58 cases) or a Kim-Ray Greenfield filter (36 cases); one patient who had a double inferior vena cava underwent double PIIVC with a Greenfield filter. The patients (56 women and 42 men) were between 22 and 84 years old (average 60.6 years). Phlebocavography was performed pre-operatively in 93 patients (95 p. 100) and showed thrombus in the IVC (21 cases), common iliac vein (20 cases), ilio-femoral vein (32 cases), femoral vein (15 cases), popliteal and/or sural vein (4 cases); the investigation was considered normal in 1 patient. The diagnosis of pulmonary embolism (PE) was made in 86 patients (87.7 p. 100) on clinical and/or pulmonary scintigraphy and/or angiography data. The main indications for PIIVC were major PE (56 cases) or a threatening venous thrombosis (27 cases); other indications included recurrent PE despite adequate anticoagulation, patients with contra-indications to anti-coagulant therapy and pulmonary hypertension due to thromboembolism; 4 PIIVC were carried out during pulmonary embolectomy on cardiopulmonary bypass. The operative mortality was 3.06 p. 100 (3/98) with a global early mortality of 10.2 p. 100 (10/98); morbidity was 12.2 p. 100 (12/98); there were 5 failures of PIIVC. The long-term outcome was studied in the first 80 cases with a mean follow-up of 18 months (4 to 48 months).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1985

[Associated lesions in closed injuries of the thorax: right bronchial rupture, rupture of the right subclavian artery, and bilateral fracture of the 1st rib].

A patient presented with rupture of right bronchus associated with rupture of the homolateral subclavian artery (diagnosed secondarily at the false aneurysm stage) and bilateral fracture of the 1st rib. Two stage repair operation provided lasting recovery. This case is used as a basis for emphasizing the diagnostic problems raised by combined endothoracic lesions, the need for systematic investigation of possible presence of a lesion of subclavian artery in patients with fracture of 1st rib, and finally various operative tactics (in the framework of false aneurysms of proximal subclavian vessels).

Adolescent↗
PubMed1983

[Painful sciatic rubbing caused by benign synovioma of the spinal joints. Apropos of 4 cases].

Synovioma, a benign neoplasm arising from pigmented villonodular synovium or synovitis, is uncommon. It involves the tendons and joints of the finger, ankle and foot. In this study four cases of villonodular synovioma of spinal joints are reported. The authors studied 555 cases of patients operated for sciatica due to herniated disk. Histopathology showed that in four out of 555 cases sciatica was found to be due to synoviomas of the spinal joints. The patients, three women and one man, were between 54 and 70 years of age and each had had a long history of low back pain with episodes of sciatica. Clinical evaluation at the time of surgery showed moderate severity of signs and symptoms. Roentgenographic studies of all four cases revealed osteoarthritic changes of vertebral apophyses, with two cases of spondylolisthesis. The pathogenesis of synovioma remains controversial and its histopathological characterization -hyperplasia VS/true tumours- has not yet been determined. It is possible that the number of recorded cases of sciatica due to synoviomas is small because surgical and pathological studies in patients with sciatica associated with osteoarthritic changes have not been adequately performed. Surgery consists of a large resection of the capsule and ligament including resection of intraspinal extension. Because this study involves only four cases, the first of which occurred in 1977, the possibility of recurrence cannot be evaluated.

Aged↗